Case Report: Interdisciplinary evaluation of an expansive process at the clivus

Introduction Tumors in the area of the clivus are very rare. The most common symptom is an abducens palsy with resulting double vision due to the anatomical proximity to the course of the cranial nerve VI. Chordoma represents the most common entity. Bone metastasis to the clivus has been described in the literature primarily in case reports. Here, prostate, breast, hepatocellular, pulmonary and follicular thyroid carcinomas, among others, have been identified as primaries.

Patient and methods We report an 87-year-old patient who initially presented with a new-onset right abducens palsy. An MRI showed an expansive lesion of the clivus with protrusion into the right sphenoid sinus, so an endonasal endoscopic sampling was performed at our Department of Otorhinolaryngology.

Results The histopathological results were compatible with a metastasis of an adenocarcinoma of the prostate. In the interdisciplinary tumor conference was decided to present the case to the Department of Urology, where the diagnosis was confirmed and a combined therapy consisting of a LHRH analogue and Apalutamid was initiated.

Discussion Prostate cancer is most commonly associated with hematogenous bone metastases, particularly affecting the spine; the clivus is a rarity. ENT medicine can offer a minimally invasive diagnostic strategy through the possibility of endoscopic sampling, particularly at the clivus. Due to low morbidity, these procedures are preferable to neurosurgical microscopic approaches, especially in older patients.

Publikationsverlauf

Artikel online veröffentlicht:
24. Mai 2022